Atch E - Time Sheet.xlsx

XLSX spreadsheet 13 KB Posted

Attached to
BIA Set-Aside: Pathology Physicians at PIMC
Solicitation number
RFQ-25-PHX-002
Issued by

About this file

This document is a timesheet for contract services provided to the Phoenix Indian Medical Center (PIMC) under Contract Number 75H712. The timesheet requires the printed name, signature, and date of the Pathology Physician provider, along with a description of the hours worked (e.g., call-back, on-call, overtime, regular time). The timesheet must be verified by the Department Manager and approved by the Certified Contracting Officer's Representative (COR).

The related federal contract opportunity is for Pathology Physician Services at PIMC. This is a Buy Indian Act set-aside, meaning only companies that are at least 51% owned by a Native American or Alaska Native will be considered for award. PIMC requires a total of two candidates, one for a full-time position and one for a part-time position. Physicians must have completed a Pathology residency, hold an active and unrestricted medical license in Arizona or another U.S. state or territory, and be certified in BLS and ACLS. Proposals must be submitted to Jeremiah Murrell at the Indian Health Service by 3:00 PM EST on 11/11/2024.

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Text version

Sheet1

PHOENIX INDIAN MEDICAL CENTER
STANDARD TIMESHEET FOR CONTRACT SERVICES

CONTRACT NUMBER: 75H712 CONTRACTOR (Company Name)

PRINTED PROVIDER'S NAME:____________________________________ SERVICE PROVIDED: PATHOLOGY PHYSICIAN SERVICES

SIGNATURE OF PROVIDER: ___________________________________________________ DATE SIGNED: _____________________________

(Description of Hours: Call-Back, On-Call, Overtime, Regular Time, etc. - # Hours, Description of Hours, Hours Need to Match Invoice/Contract)

WEEK OF _________________________________________
WeekdayDateTime INLunch OutLunch InTime OUTTotal HoursDescription of Hours
WEEK OF ________________________________________
WeekdayDateTime INLunch OutLunch InTime OutTotal HoursDescription of Hours

VERIFIED BY Dept. Manager (Printed Name):_____________________________________ Signature: ___________________________________________________

APPROVED BY Certified COR (Printed Name):_____________________________________ Signature: __________________________________________________

File details come from the government source that posted it. Updated .